POLYETHYLENE GLYCOL-400 + PROPYLENE GLYCOL

Source General Schedule
Body System SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS
Code & Prescriber Medicinal Product Pack
(Name, form & strength and pack size)
Max qty packs Max qty units No. of repeats DPMQ Max Safety Net General Patient Charge
13100LMPNP POLYETHYLENE GLYCOL-400 + PROPYLENE GLYCOL
polyethylene glycol-400 0.4% + propylene glycol 0.3% eye drops, 30 x 0.8 mL unit doses (PI, CMI)
2 2 5 $33.08 $34.39 $38.93
Available brands
Systane
space

POLYETHYLENE GLYCOL-400 + PROPYLENE GLYCOL

Source General Schedule
Body System SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS
Code & Prescriber Medicinal Product Pack
(Name, form & strength and pack size)
Max qty packs Max qty units No. of repeats DPMQ Max Safety Net General Patient Charge
13113EOP POLYETHYLENE GLYCOL-400 + PROPYLENE GLYCOL
polyethylene glycol-400 0.4% + propylene glycol 0.3% eye drops, 30 x 0.8 mL unit doses (PI, CMI)
2 2 5 $33.08 $34.39 $38.93
Available brands
Systane
space

POLYETHYLENE GLYCOL-400 + PROPYLENE GLYCOL

Source General Schedule
Body System SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS
Code & Prescriber Medicinal Product Pack
(Name, form & strength and pack size)
Max qty packs Max qty units No. of repeats DPMQ Max Safety Net General Patient Charge
5524ROP POLYETHYLENE GLYCOL-400 + PROPYLENE GLYCOL
polyethylene glycol-400 0.4% + propylene glycol 0.3% eye drops, 15 mL (PI, CMI)
1 1 5 $15.30 $16.61 $21.15
Available brands
Systane
space

POLYETHYLENE GLYCOL-400 + PROPYLENE GLYCOL

Source General Schedule
Body System SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS
Code & Prescriber Medicinal Product Pack
(Name, form & strength and pack size)
Max qty packs Max qty units No. of repeats DPMQ Max Safety Net General Patient Charge
5532EOP POLYETHYLENE GLYCOL-400 + PROPYLENE GLYCOL
polyethylene glycol-400 0.4% + propylene glycol 0.3% eye drops, 28 x 0.8 mL unit doses (PI, CMI)
2 2 5 $31.68 $32.99 $37.53
Available brands
Systane
space

POLYETHYLENE GLYCOL-400 + PROPYLENE GLYCOL

Source General Schedule
Body System SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS
Code & Prescriber Medicinal Product Pack
(Name, form & strength and pack size)
Max qty packs Max qty units No. of repeats DPMQ Max Safety Net General Patient Charge
8676PMPNP POLYETHYLENE GLYCOL-400 + PROPYLENE GLYCOL
polyethylene glycol-400 0.4% + propylene glycol 0.3% eye drops, 15 mL (PI, CMI)
1 1 5 $15.30 $16.61 $21.15
Available brands
Systane
space

POLYETHYLENE GLYCOL-400 + PROPYLENE GLYCOL

Source General Schedule
Body System SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS
Code & Prescriber Medicinal Product Pack
(Name, form & strength and pack size)
Max qty packs Max qty units No. of repeats DPMQ Max Safety Net General Patient Charge
9170PMPNP POLYETHYLENE GLYCOL-400 + PROPYLENE GLYCOL
polyethylene glycol-400 0.4% + propylene glycol 0.3% eye drops, 28 x 0.8 mL unit doses (PI, CMI)
2 2 5 $31.68 $32.99 $37.53
Available brands
Systane
space

POLYETHYLENE GLYCOL-400 + PROPYLENE GLYCOL

Source General Schedule
Body System SENSORY ORGANS > OPHTHALMOLOGICALS > OTHER OPHTHALMOLOGICALS
Code & Prescriber Medicinal Product Pack
(Name, form & strength and pack size)
Max qty packs Max qty units No. of repeats DPMQ Max Safety Net General Patient Charge
9219FMP POLYETHYLENE GLYCOL-400 + PROPYLENE GLYCOL
polyethylene glycol-400 0.4% + propylene glycol 0.3% eye drops, 15 mL (PI, CMI)
1 1 11 $15.30 $16.61 $21.15
Available brands
Systane
space


  • Legend
  • MPMedical Practitioner
  • NPNurse Practitioner
  • OPOptometrist